A Classification of Motivation and Behavior Change Techniques … · 2020. 8. 6. · SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 1 A Classification of Motivation and Behavior Change

SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 1

A Classification of Motivation and Behavior Change Techniques Used in Self-

Determination Theory-Based Interventions in Health Contexts

Pedro J. Teixeira1, Marta M. Marques2, Marlene N. Silva1, Jennifer Brunet3, Joan Duda4, Leen

Haerens5, Jennifer La Guardia6, Magnus Lindwall7, Chris Lonsdale8, David Markland9, Susan

Michie10, Arlen C. Moller11, Nikos Ntoumanis12, Heather Patrick13, Johnmarshall Reeve8,

Richard M. Ryan8, Simon J. Sebire14, Martyn Standage15, Maarten Vansteenkiste5, Netta

Weinstein16, Karin Weman-Josefsson17, Geoffrey C. Williams18, Martin S. Hagger19,20

1University of Lisbon, 2Trinity College Dublin, 3University of Ottawa, 4University of

Birmingham, 5Ghent University, 6Omada Health, 7University of Gothenburg, 8Australian

Catholic University, 9Bangor University, 10University College London, 11Illinois Institute of

Technology, 12Curtin University, 13Carrot, Inc, 14University of Bristol, 15University of Bath,

16Cardiff University, 17Halmstad University, 18University of Rochester, 19University of

California, Merced, 20University of Jyväskylä

© 2020, American Psychological Association. This paper is not the copy of record and may not

exactly replicate the final, authoritative version of the article. Please do not copy or cite

without authors’ permission. The final article will be available, upon publication, via its DOI:

10.1037/mot0000172

Full citation: Teixeira, P. J., Marques, M. M., Silva, M. N., Brunet, J., Duda, J., Haerens, L., La

Guardia, J., Lindwall, M., Londsdale, C., Markland, D., Michie, S., Moller, A. C., Ntoumanis,

N., Patrick, H., Reeve, J., Ryan, R. M., Sebire, S., Standage, M., Vansteenkinste, M., . . .

Hagger, M. S. (2020). Classification of techniques used in self-determination theory-based

interventions in health contexts: An expert consensus study. Motivation Science.

https://doi.org/10.1037/mot0000172

Author Note

Martin S. Hagger’s contribution was supported by a Finnish Distinguished Professor

(FiDiPro) award from Business Finland (grant # 1801/31/2105). Marta Marques’ contribution

was funded by the Marie-Sklodowska-Curie (EDGE) Fellowship programme (grant agreement

No. 713567). We thank Eliana Carraça and Jorge Encantado for their contribution to the data

synthesis. We have no known conflict of interest to disclose. Correspondence regarding this

article should be addressed to Martin S. Hagger, SHARPP Lab, Psychological Sciences,

University of California, Merced, 5200 N. Lake Rd., Merced, CA 95343, email:

[email protected]


Abstract

While evidence suggests that interventions based on self-determination theory have efficacy in

motivating adoption and maintenance of health-related behaviors, and in promoting adaptive

psychological outcomes, the motivational techniques that comprise the content of these

interventions have not been comprehensively identified or described. The aim of the present

study was to develop a classification system of the techniques that comprise self-determination

theory interventions, with satisfaction of psychological needs as an organizing principle.

Candidate techniques were identified through a comprehensive review of self-determination

theory interventions and nomination by experts. The study team developed a preliminary list of

candidate techniques accompanied by labels, definitions, and function descriptions of each.

Each technique was aligned with the most closely-related psychological need satisfaction

construct (autonomy, competence, or relatedness). Using an iterative expert consensus

procedure, participating experts (N=18) judged each technique on the preliminary list for

redundancy, essentiality, uniqueness, and the proposed link between the technique and basic

psychological need. The procedure produced a final classification of 21 motivation and

behavior change techniques (MBCTs). Redundancies between final MBCTs against techniques

from existing behavior change technique taxonomies were also checked. The classification

system is the first formal attempt to systematize self-determination theory intervention

techniques. The classification is expected to enhance consistency in descriptions of self-

determination theory-based interventions in health contexts, and assist in facilitating synthesis

of evidence on interventions based on the theory. The classification is also expected to guide

future efforts to identify, describe, and classify the techniques that comprise self-determination

theory-based interventions in multiple domains.

Keywords: Self-determination theory interventions; Autonomous motivation; Autonomy

support; Need satisfaction; Motivational technique


A Classification of Motivation and Behavior Change Techniques Used in Self-Determination

Theory-Based Interventions in Health Contexts

Chronic non-communicable diseases and conditions such as cancer, cardiovascular

disease, obesity, and diabetes contribute to a large proportion of population morbidity and

mortality worldwide, and also account for a substantive proportion of healthcare costs (Li et

al., 2018; OSBBR, 2016; The US Burden of Disease Collaborators, 2018). In response,

national departments of health and healthcare organizations have advocated prevention through

interventions to promote participation in health-related behaviors, such as participation in

physical activity, healthy eating, avoiding tobacco, and treatment adherence (Dunton,

Cousineau, & Reynolds, 2010; Ueda et al., 2018; Wood et al., 2018). Given that current

population-level participation in these behaviors is insufficient to confer health benefits and

prevent chronic disease, developing behavioral interventions and testing their efficacy and

effectiveness in increasing health behavior participation rates is considered a public health

priority (Bartholomew & Mullen, 2011; Glanz & Bishop, 2010; Johnson & Acabchuk, 2018).

Psychologists and behavioral scientists have applied motivational theories to identify

the modifiable factors and mechanisms that relate to health behaviors, which can be used as a

basis for the development and evaluation of behavioral interventions (Hagger, Cameron,

Hamilton, Hankonen, & Lintunen, 2020; Rothman et al., 2015; Sheeran, Klein, & Rothman,

2017). Self-determination theory (Deci & Ryan, 1985, 2000; Ryan & Deci, 2017) is a

prominent theory of motivation that has demonstrated promise in identifying the psychological

factors and processes that determine motivated behavior in diverse health contexts. In addition,

interventions based on the theory have been shown to be efficacious in promoting motivation

toward, and actual participation in, health behavior across multiple populations, contexts, and

behaviors (e.g., Chatzisarantis & Hagger, 2009; Emm-Collison, Jago, Salway, Thompson, &

Sebire, 2019; Gillison, Rouse, Standage, Sebire, & Ryan, 2018; Ng et al., 2012; Teixeira,

Carraca, Markland, Silva, & Ryan, 2012; Williams, McGregor, Sharp, Kouides, et al., 2006;


Williams, McGregor, Sharp, Levesque, et al., 2006). While there has been some previous

research specifying and defining the content of self-determination theory-based interventions

in education contexts (e.g., Aelterman et al., 2019; Cheon & Reeve, 2013; Reeve & Jang,

2006; Su & Reeve, 2011; Tessier, Sarrazin, & Ntoumanis, 2008), there have been few attempts

to develop descriptions of the essential and distinct techniques that comprise interventions

based on the theory (Gillison et al., 2018; Ryan, Patrick, Deci, & Williams, 2008). Moreover,

considerable variability in how the theory is currently applied and tested in health behavior

settings has been noted (Silva, Marques, & Teixeira, 2014). For example, interventions based

on the theory have tended not to identify the theory-based constructs targeted by the

intervention content, or clearly specify links between the content with the targeted constructs,

or conduct appropriate analyses to test whether the intervention content leads to changes in

both the construct and the outcome of interest, often a behavioral measure.

There is, therefore, a need to systematically identify and describe the practices or

techniques that comprise self-determination theory-based interventions (Ryan et al., 2008).

Identifying these techniques will be valuable to stakeholders (e.g., researchers, administrators)

interested in developing behavioral interventions based on the theory and conducting research

to establish their efficacy and effectiveness since it will provide a common set of descriptions

of the techniques that make up the content of the interventions. It will also contribute to

research aimed at developing an evidence base of optimally efficacious and effective

intervention techniques based on the theory. The purpose of the present study was to develop

an organized description of the essential techniques implemented within interventions based on

self-determination theory in health contexts using an expert consensus approach.

Self-Determination Theory and Basic Psychological Needs

Self-determination theory is a theory of human motivation that has demonstrated

efficacy in predicting motivated behavior in multiple contexts and populations, and for a

variety of behaviors (Deci & Ryan, 1985, 2000; Ryan & Deci, 2017), including health


behaviors such as physical activity, healthy eating, and smoking cessation (Ng et al., 2012;

Patrick & Williams, 2012; Ryan & Deci, 2017). Self-determination theory is unique among

theories of motivation due to its focus on the quality of motivation rather than quantity alone.

Self-determination theory emphasizes the importance of the kind of motivation that drives

people’s behavior, alongside considerations of how much they are motivated. Central to the

theory is the distinction between self-determined or autonomous, and non-self-determined or

controlled forms of motivation (Deci & Ryan, 2000; Ryan & Deci, 2017). These motivational

subtypes reflect the degree to which actions are fully self-endorsed by the individual.

Autonomous motivation reflects self-endorsed reasons for engaging in a behavior or pursuing a

particular goal. Individuals acting for autonomous reasons experience their actions as freely

chosen and consistent with their genuine sense of self, values, and personal goals, and feel that

they are the origin of their actions (Ryan & Deci, 2006). In contrast, controlled motivation

reflects reasons for acting that are not self-endorsed. Individuals citing controlled reasons for

action view their behavior as originating outside their self and feel that their actions are

controlled by external contingencies (Sheldon & Elliot, 1998; Sheldon et al., 2004). A third

form of regulation is amotivation, a state which reflects a lack of any motivational force to act.

Individuals who feel their actions are amotivated offer no discernible reason, motive, or

intention for action (Deci & Ryan, 2000; Ntoumanis, Pensgaard, Martin, & Pipe, 2004). Across

numerous health contexts, a cogent body of research has consistently found that autonomous

forms of motivation are associated with behavioral persistence and healthier psychological

outcomes (Hagger & Chatzisarantis, 2015; Ng et al., 2012; Pihu, Hein, Koka, & Hagger, 2008;

Ryan & Deci, 2017; Teixeira et al., 2012).

A further key premise of the theory is that the quality of motivation experienced by

individuals when acting is determined by the extent to which they view their actions to be

consistent with, and in the service of, three basic psychological needs – autonomy,

competence, and relatedness (Deci & Ryan, 2000; Ryan & Deci, 2017). The needs are


considered universal, and are implicated in the process that gives rise to the type of motivation

experienced in behavioral contexts (i.e., hallmarks) of each of the three psychological needs.

The need to experience autonomy reflects actions as freely chosen and self-endorsed, reflecting

the need for individuals to experience a sense of ownership and responsibility over their

actions. The need for competence refers to the experience of being effective in one’s

environment, mastering mentally or physically challenging tasks, and perceiving sufficient

capacity to perform actions. The need for relatedness reflects the need to feel accepted and

respected, and to gain a sense of connectedness and mutual concern with important others

(Deci & Ryan, 2000; Ryan & Deci, 2017). A summary of the three basic psychological needs

from the theory is provided in Table 1. Large-scale research has supported the primacy of the

needs for autonomy, competence, and relatedness above other candidate needs (Sheldon, Elliot,

Kim, & Kasser, 2001) and across different cultural contexts (Chen et al., 2015). In addition,

satisfaction of the needs have been shown to mediate the associations between autonomous

motivation and behavioral persistence in multiple contexts including health behavior change

(Ng et al., 2012). Analogously, the frustration of these basic psychological needs has been

shown to mediate the associations between controlled forms of motivation and behavioral

disengagement and lower wellbeing (Bartholomew, Ntoumanis, Ryan, Bosch, & Thogersen-

Ntoumani, 2011; Haerens, Aelterman, Vansteenkiste, Soenens, & Van Petegem, 2015; Silva et

al., 2014; Vansteenkiste & Ryan, 2013).

Whether a person’s psychological needs are satisfied or frustrated depends largely on

the extent to which the person’s surrounding environment and relationships support or thwart

those needs (Deci, Eghrari, Patrick, & Leone, 1994; Deci & Ryan, 1985; Ryan & Deci, 2017).

The behaviors displayed, or messages provided, by social agents (e.g., health practitioners,

teachers, coaches, parents, peers, family members and colleagues) operating in an individual’s

social environment, or the content of messages communicated by other means (e.g., leaflets,

websites, text messages, smartphone ‘apps’), can be more or less supportive or thwarting of the


psychological needs. If the agents’ behaviors or messages support the satisfaction of

individuals’ psychological needs, then these individuals are likely to experience their actions as

autonomously motivated, and may engage with and/or maintain health behaviors (Deci &

Ryan, 2000; Ntoumanis, Quested, Reeve, & Cheon, 2018; Ryan & Deci, 2017). In contrast,

behaviors and messages that do not support, or actively hinder, satisfaction of psychological

needs likely undermine autonomous motivation and promote controlled forms of motivation or

amotivation, which may lead to maladaptive outcomes and behavioral disengagement (Deci &

Ryan, 2000; Ntoumanis et al., 2018; Ryan & Deci, 2017). Providing guidance on the behaviors

displayed by social agents, and specifying the content of messages, are potentially effective

means to promote autonomous motivation and sustained behavior change. The process by

which these interventions affect the quality of motivation is through the satisfaction of the

three basic psychological needs. Satisfaction of the needs is considered a key mediator of self-

determination theory-based interventions on outcomes, particularly behavior change.

Ryan, Patrick, Deci, and Williams (2008) proposed an integrative process model that

draws together the key components of self-determination theory. The model specifies the

theory-based processes by which need supportive actions and messages, and other dispositional

factors, relate to health behavior participation and outcomes. An adapted form of this model is

presented in Figure 1. As specified in the model, social agents’ (e.g., health practitioners,

teachers, coaches, parents, peers, family members and colleagues) behaviors and messages that

support autonomy, competence, and relatedness determine whether actors’ basic psychological

needs are supported or frustrated (path 1, Figure 1). The extent to which needs are satisfied or

frustrated will determine the type of motivation experienced (path 2, Figure 1), and the extent

to which the individual engages in, and persists with, health-related behaviors (path 3, Figure

1). The experience of actions as autonomous, controlled, or amotivated will also determine

whether an individual experiences adaptive emotional outcomes and overall levels of

satisfaction (path 4, Figure 1). Finally, the type of motivation experienced will determine the


extent to which individuals report adaptive or maladaptive mental (path 5a, Figure 1) and

physical (path 5b, Figure 1) health-related outcomes, respectively. Research has supported the

proposed relations among the constructs of the process model, including relations between

need-supportive interventions and need satisfaction, and between these interventions and

behavioral and health-related outcomes (Ng et al., 2012; Su & Reeve, 2011). There is also

evidence demonstrating effects of interventions based on the theory on health behavior through

need satisfaction and autonomous motivation, but tests of these mediating effects are relatively

sparse (Chatzisarantis & Hagger, 2009; Duda et al., 2014; Ng et al., 2012).

Specifying the ‘Techniques’ of Self-Determination Theory Interventions

As outlined in the previous section, the specific behavioral and communicative

techniques can both signal and support basic psychological need satisfaction and, in turn,

promote autonomous motivation. Often, interventions based on self-determination theory

comprise a number of these techniques, and previous work has aimed to identify and catalogue

these techniques. For example, research in the field of education has developed autonomy

support training programs in which teachers are trained on the necessary skills and techniques

to foster students’ need satisfaction in classroom contexts (e.g., Aelterman et al., 2019; Cheon

& Reeve, 2013; Cheon, Reeve, & Moon, 2012; Cheon, Reeve, & Ntoumanis, 2018; Lonsdale

et al., 2019; Reeve & Jang, 2006; Reeve et al., 2014; Tessier, Sarrazin, & Ntoumanis, 2010).

Within the context of education, Reeve and Jang (2006) produced a list of instructional

behaviors and lesson content that classroom teachers were observed to use to support

autonomy. This list has been updated and organized according to whether the behaviors were

autonomy-supportive or controlling (Reeve et al., 2014). Behaviors and instructions classified

as autonomy-supportive were: taking the students’ perspective, creating opportunities for

student input and initiative, providing explanatory rationales for teacher requests,

acknowledging and accepting expressions of negative affect, and displaying patience.

Instructional behaviors considered to be controlling were: taking only the teacher’s


perspective, introducing extrinsic incentives, uttering directives without explanations, relying

on pressuring language to silence students’ complaints, and pushing students into immediate

compliance with the teacher’s agenda.

These descriptions have been incorporated into the training programs designed to

develop autonomy-supportive behaviors in teachers and help them avoid the use of controlling

behaviors. By intervening to change teachers’ autonomy-supportive techniques, the programs

are expected to promote students’ autonomous motivation in class and, over time, better

academic engagement and attainment. The techniques included in these programs have also

been used in observational checklists to assess teachers’ use of autonomy supportive strategies

in class, and to assess changes in the use of more autonomy supportive strategies after their

delivery. In addition, this approach has been used to describe autonomy supportive intervention

content in multiple contexts (e.g. healthcare, education, the workplace, sport and coaching,

parenting, and therapy) and guide development of future educational interventions based on

self-determination theory (e.g., Aelterman, Vansteenkiste, Van den Berghe, De Meyer, &

Haerens, 2014; Carpentier & Mageau, 2016; Froiland, 2015; Gagné & Deci, 2005; Halvari &

Halvari, 2006; Jungert et al., 2015; McLachlan & Hagger, 2010; Zuroff et al., 2007).

There is also research that has isolated techniques aimed at promoting motivation

through support for competence and relatedness needs. Techniques to support competence

focus on promoting a sense of satisfaction on tasks or toward goals, with a focus on making

progress toward self-referenced goals, attaining mastery, and developing greater skills. For

example, research has identified three essential techniques for competence support: stating

clear expectations; providing ‘how-to’ guidance; and giving constructive/positive feedback.

Studies have demonstrated the efficacy of these techniques in promoting motivation and

adaptive outcomes (e.g., Carpentier & Mageau, 2016; Jang, Reeve, & Deci, 2010; Sierens,

Vansteenkiste, Goossens, Soenens, & Dochy, 2009; Tessier et al., 2010). A parallel line of

research has focused on techniques that support relatedness. Research identified several


essential techniques purported to support relatedness: fostering individualized conversation;

promoting cooperation and teamwork; demonstrating awareness and care; and engaging in

warm, friendly communication (Sparks, Dimmock, Lonsdale, & Jackson, 2016; Sparks,

Lonsdale, Dimmock, & Jackson, 2017). Taken together, these research findings indicate sets of

techniques that promote motivation and behavioral outcomes through support for autonomy,

competence, and relatedness needs.

While numerous approaches to specifying the content of self-determination theory

interventions exist, no formal system has been developed to identify and describe the

techniques that comprise self-determination theory interventions. By comparison, relatively

recent research has developed systems to identify, describe, and organize the essential

techniques used in behavioral interventions more broadly. The development of classification

systems for these techniques, referred to as behavior change techniques, is a prerequisite to be

able to consistently describe behavioral interventions. The classification of behavior change

techniques as taxonomies are typically developed through expert consensus methods. The

development of taxonomies of behavior change techniques using the expert consensus method

provides an opportunity to develop a formal organized description of techniques that comprise

self-determination theory interventions. Development of a formal classification of techniques

of self-determination theory interventions will provide the research community with a common

set of terms to describe the content of interventions based on the theory, and allow for future

empirical testing of which techniques or sets of techniques are most efficacious in promoting

motivation and associated outcomes.

The Present Study

The purpose of the present study was to identify, define, and classify the unique

techniques that comprise interventions based on self-determination theory, and develop the

first classification of techniques comprising self-determination theory interventions in health

behavior contexts. We used an iterative expert-consensus method to develop the classification,


consistent with methods used to develop taxonomies of behavior change techniques (Kok et al.,

2016; Michie, Ashford, et al., 2011; Michie, Hyder, Walia, & West, 2011; Michie et al., 2013;

Michie et al., 2015). Unlike existing behavior change technique taxonomies, we organized the

current classification system according to links between the techniques and the psychological

constructs stipulated in the process model based on self-determination theory (see Figure 1;

Ryan et al., 2008). Specifically, we hypothesized intervention techniques to exert their effects

on behavior and associated outcomes through changes in psychological need satisfaction, as

well as autonomous and controlled forms of motivation, and amotivation. As the focus of the

techniques was on change in motivation types defined by self-determination theory, rather than

behavior specifically, the identified techniques are referred to as motivation and behavior

change techniques (MBCTs). The development of the classification system1 should be viewed

as a first step in an ongoing, iterative process, progressively informed by empirical

investigation of the effects of MBCTs on behavioral outcomes mediated by satisfaction of

psychological needs of autonomy, competence, and relatedness.

Method

The unique MBCTs based on self-determination theory were identified, labelled,

defined, and classified using an iterative expert consensus procedure, similar to procedures

used to develop taxonomies of behavior change techniques (e.g., Michie, Ashford, et al., 2011;

Michie, Hyder, et al., 2011; Michie et al., 2013; Michie et al., 2015). An MBCT was defined as

a distinct, observable and replicable component of an intervention, designed to influence a

person’s behavior directly or indirectly by impacting the person’s2 perceptions of autonomy,

relatedness, and/or competence need satisfaction in relation to a particular behavior or group of

1We refer to a classification system rather than taxonomy as our proposed list of MBCTs is not expressed as a

taxonomic structure, i.e., a hierarchical relationship in which lower level entities have only one type of

relationship with a higher-order entity. The current classification is not, therefore, considered a true taxonomy. 2The ‘person’ refers to the individual or group (e.g., a client, patient, intervention participant) that is the target of

the intervention.


related behaviors. The definition was based on previous definitions used in taxonomies of

behavior change techniques (Michie et al., 2013), and a recent classification of motivational

interviewing techniques (Hardcastle, Fortier, Blake, & Hagger, 2017). Descriptions of

motivational interviewing techniques were useful to inform the definition due to the expressed

conceptual links between motivational interviewing and self-determination theory-based

intervention techniques (Markland, Ryan, Tobin, & Rollnick, 2005; Vansteenkiste & Sheldon,

2006). For example, many of the techniques from motivational interviewing, such as

supporting autonomy and exploring change expectations, have good congruence with strategies

used in autonomy-support interventions focusing on choice and setting self-referenced goals

(Hardcastle et al., 2017; Vansteenkiste, Williams, & Resnicow, 2012).

Participants

Experts (N = 18, 11 men, 7 women) participating in the consensus procedure were

leading researchers with expertise in designing, conducting, and evaluating self-determination

theory-based interventions in the health domain. Participants were identified from the network

of self-determination theory researchers (www.selfdeterminationtheory.org) and recruited by

email. Fourteen were psychologists, three were physical activity specialists, and one was a

physician and health psychologist. Experts were based in the United Kingdom (n = 5), United

States (n = 4), Australia (n = 3), Belgium (n = 2), Sweden (n = 2), Canada (n = 1), and South

Korea (n = 1). The core study team (PJT, MM, MS, MSH) developed the first list of

techniques, and were responsible for the feedback, discussion, and refinement of the MBCTs.

Their collective expertise is in social psychology, behavioral science, medicine, preventive

medicine, and exercise and nutrition sciences, and all have specific expertise in self-

determination theory.

Procedure

A seven-step expert consensus procedure was adopted (Table 2). The procedure began

with the development of an exhaustive list of candidate techniques based on the pooled


knowledge of the lead author group and a content analysis of previous self-determination

theory interventions. This was followed by a series of expert consensus exercises aimed at

refining descriptions and content of the candidate items, removing redundancy, and

establishing links between the techniques and need-satisfaction constructs from self-


Step 1: Development of the first list of MBCTs. The study team members generated

an initial ‘long list’ of distinct MBCTs used in self-determination theory-based interventions,

derived from a content analysis of published interventions, manipulations, and autonomy

support training programs (e.g., Chatzisarantis & Hagger, 2009; Cheon & Reeve, 2013; Deci et

al., 1994; Haerens et al., 2013; McLachlan & Hagger, 2010; Patrick, Resnicow, Teixeira, &

Williams, 2013; Reeve & Jang, 2006; Su & Reeve, 2011; Tessier et al., 2008)3. For each

potential distinct MBCT, initial labels and definitions were formulated and discussed among

the core study team members (PJT, MM, MS, MSH) until majority agreement was achieved.

Specifically, as in taxonomies of behavior change techniques (e.g., Michie, Ashford, et al.,

2011; Michie, Hyder, et al., 2011; Michie et al., 2013; Michie et al., 2015), definitions of

MBCTs were formulated using active verbs (e.g., elicit, prompt, use).

Step 2: Consensus exercise – Round 1. An initial group of experts (N = 8) was asked

to provide written feedback on the initial list of MBCTs from Step 1, regarding the clarity and

content of each label and definition, as well as critical details any MBCTs would insufficiently

capture4.

Step 3: Consensus exercise – Round 2. Based on these experts’ comments from

Round 1 and on further discussion among the core team (PJT, MM, MS, MSH), the initial list

of MBCTs was refined. Comments from Round 1 led to the decision to conduct a second round

with an additional pool of experts. In addition, the core team added a function to each MBCTs.

3References of all included studies are available as an online supplement: https://osf.io/ytfbq/ 4Guidelines provided to the experts are available as an online supplement: https://osf.io/f42pe/

https://osf.io/ytfbq/https://osf.io/f42pe/


The function description outlined the purpose of the MBCT thereby specifying how it targets

the proposed primary mechanism of action (i.e., the corresponding need from self-

determination theory). The label, definition, and function descriptions of each MBCT were

discussed among the core study team members until majority agreement was achieved.

In this round, a larger group of experts (N = 18), including the eight experts from

Round 1, was asked to respond to a maximum of eight questions about each of 24 MBCTs

from the refined list through an online questionnaire, using online surveys administered via the

QualtricsTM software. The task was divided in two parts. In the first part, experts rated the

need-sensitivity of each MBCT, that is, the extent to which each MBCT targeted each of the

three psychological needs – autonomy, relatedness and competence, starting with the need

hypothesized to be most closely related to the MBCT (Questions 1, 2, and 3)5. Reponses were

provided on a 5-point scale (1 = definitely no and 5 = definitely yes). Experts also rated the

essentiality of each MBCT is to a self-determination theory-based health intervention

(Question 4; coded 1 = essential, 2 = important but not essential, 3 = not important, and 4 =

uncertain/don’t know). In the second part, experts assessed the specificity of each MBCT by

assessing its uniqueness in relation to any of the other MBCTs listed (Question 5; coded 1 =

sufficiently unique, 2 = overlapping considerably, and 3 = uncertain/don’t know). If experts

responded “overlapping considerably”, they were asked to indicate which of the other

technique(s) the MBCT overlapped with (Question 6), and what changes could be done to

reduce it (Question 7). Finally, all experts were asked if they wanted to make any other

comments on each MBCT, such as changing labels, definitions, or function descriptions

(Question 8). Responses to this question were optional, and it used an open-ended response

format.

5The reference list of definitions of basic psychological needs and their focus used by the experts is available as an

online supplement: https://osf.io/msu97/

https://osf.io/msu97/


Prior to participating in this exercise, experts were informed about the expected task

completion time and they could interrupt at any point, preferably after a set of related questions

(i.e., an MBCT). They were also asked to familiarize themselves with the full list of MBCTs –

label, definition, and function description – before starting the task. Follow-up reminders were

sent to experts after 10 days, and all responses were submitted within 2 weeks.

To avoid confusion during the consensus exercise, experts were further informed that

(1) when rating the MBCT-need link, each link should be considered separately, irrespective of

whether other needs are targeted by the same MBCT; (2) each MBCT should be considered on

its own, even if the MBCT is rarely used in isolation in self-determination theory-based

interventions; (3) when rating the uniqueness of each MBCT, potential interactions between

these techniques should not be considered; and (4) presenting each need separately does not

imply that the effect of any MBCT on a given need is independent of other needs.

For the specificity, essentiality, and uniqueness questions, frequencies and mode

averages of responses were calculated for each MBCT. Each MBCT was marked as requiring

further consideration, if at least one-quarter (25%) of the experts considered: (1) the technique

did not target the need theoretically hypothesized to be more closely linked to the MBCT (by

responding ‘definitely no’, ‘probably no’ or ‘uncertain’ to Question 1); (2) at least one of the

other two needs to be strongly targeted by the MBCT (i.e. by responding ‘definitely yes’ to

Questions 2 or 3); (3) the technique to be unimportant in a self-determination theory-based

health intervention (Question 4); and (4) the technique yielded considerable overlap

considerably with other MBCTs (Question 5).

Step 4: Discussion and feedback from core team members. Based on the expert

feedback in step 3, the core team members refined the list of MBCTs, based on the results

Round 2 of the consensus exercise. For MBCTs rated (a) not important in the context of a self-

determination theory-based intervention (Question 4), or (b) overlapping considerably with

other MBCTs (Question 5), by the panel of experts, the team discussed their removal or


rewording until majority agreement was achieved. All labels, definitions and function

descriptions were revised for comprehensiveness based on the experts’ suggestions provided in

Question 8.

Step 5: Consensus exercise – Round 3. The same group of experts (N = 18) was asked

an additional set of questions about the MBCTs that required further consideration from the

previous round; they were also asked to conduct a fine-grained review of the MBCT

descriptions for clarity. In addition, for any MBCTs added to the list in this round, experts

were asked the same set of questions as in Round 2.

For all MBCTs, where a consensus on their specificity was not reached, experts were

asked to rate how (Question 1). Experts could select one of five responses: 1 = Confident that it

is largely specific to the [basic psychological need], 2 = Uncertain/don’t know, 3 = Confident

that it is not specific, and 4 = Confident that it is not specific. It also targets [alternate basic

psychological need] to a large extent, 5 = Confident that it is not specific. It also targets

[alternate basic psychological need] and [alternate basic psychological need] to a large

extent. Experts selecting option 2 on Question 1 were asked to provide suggestions to rephrase

the function description to improve the specificity of the MBCT (Question 2; open-ended

question). Experts selecting options 3, 4, or 5 on Question 1 were asked to indicate how the

MBCT targeted each of the needs selected (i.e., the proposed function), (Question 3; open-

ended question).

For all MBCTs where a consensus on their uniqueness was not reached, experts were

asked how satisfied they were that the MBCT was sufficiently unique in relation to others

considered to be overlapping in Round 2, to justify being listed separately (Question 4; coded 1

= sufficiently unique, 2 = overlapping considerably, and 3 = uncertain/don’t know). If

participants responded “overlapping considerably”, they were asked to describe why they

considered the MCBTs to overlap, and suggest changes to the label, definition and/or function

description, to reduce overlap (Question 5 open-ended question).


Finally, experts were presented with a group of four MBCTs (randomly selected), one

at a time, and asked to review the label, definition, and function description for clarity of

English language, and suggest minor changes where appropriate. This was an optional, open-

ended response format.

As in Round 3, frequencies and mean or mode averages of responses were calculated

for each MBCT. Each MBCT was marked as requiring further consideration, if at least one-

quarter (25%) of experts considered that it was not specific to the stipulated need, and/or

targeted an alternate need, by returning a 2, 3, 4, or 5 response to Question 1 (i.e. confidence

that each MBCT is specific to each of the three psychological needs – autonomy, competence,

and relatedness), and that it overlapped considerably with one or both of the other MBCTs by

returning a 2 response to Question 4 (i.e., the MBCT is sufficiently unique in relation to other

MBCTs or considered to be overlapping).

In addition, intraclass correlation coefficients (ICC) were computed in Rounds 2 and 3

to assess inter-rater reliability of experts’ specificity, essentiality, and uniqueness ratings.

Step 6: Revision and finalization of the list of MBCTs. Based on the ratings provided

in Round 3, and suggestions for improvement, the core study team refined the list of MBCTs,

including amendments to the wording of definitions, labels, and function descriptions to make

them more distinct from each other, and exclude redundant MBCTs. No further rounds were

required.

Step 7: Comparison of MBCTs and Techniques from the Behavior Change

Techniques Taxonomy (BCTT) v1. The core study team members compared the final list of

MBCTs with the BCTTv1 (Michie et al, 2013). The aim was to identify MBCTs that could

overlap with the ones presented in the BCTTv1, and in these cases, clarify the uniqueness of

the MBCT.

Results

Initial Classification: Steps 1 and 2


The initial ‘long list’ of MBCTs identified by the core study team from the literature

review and expert nomination identified 39 candidate techniques organized under the three

psychological need satisfaction categories from self-determination theory – autonomy,

competence and relatedness6. MBCTs considered to be vague, redundant, or overlapping by

participating experts in Round 1 of the consensus method were reformulated or removed. The

revised list comprised 24 MBCTs, eight for each need satisfaction category7. The label,

definition, and function description of each MBCT was revised for clarity. A definitions key

for each psychological need under which the MBCTs were classified was also developed to

accompany the list of MBCTs.

Refining the Techniques: Steps 3 and 4

In Round 2, experts provided responses to each of the three criteria for rating the

candidate MBCTs identified in Round 1: specificity, essentiality, and uniqueness8. With

respect to the specificity criterion, all MBCTs were rated as sufficient in targeting the primary

need, with responses ranging from “probably yes” to “definitely yes”. There were some

instances where MBCTs were identified as targeting needs other than the hypothesized need.

Specifically, the “facilitate autonomous goals or outcomes” (autonomy) and “support client’s

initiatives and explorations around behavior change” (autonomy) MBCTs were rated as

“definitely yes” as also targeting competence by 38.9% and 44.4% of experts, respectively. In

addition, the “acknowledge and accept client’s perspectives” (relatedness) and “encourage

client to ask questions” (relatedness) MBCTs were both rated “definitely yes” as also targeting

autonomy by half of the experts. The “ask permission to provide information or give advice”

(relatedness) MBCT was rated “definitely yes” as also targeting autonomy by 38.9% of

6The list of MBCTs for all rounds are presented as an online supplement: https://osf.io/2vh8y 7Changes are documented in an online supplement: https://osf.io/2vh8y 8A summary table of experts’ ratings of the MBCTs in Round 2 of the consensus survey is provided as an online

supplement (https://osf.io/fu38t/), along with a table providing full results for each MBCT (https://osf.io/cf3n7/).

https://osf.io/2vh8yhttps://osf.io/2vh8yhttps://osf.io/fu38t/https://osf.io/cf3n7/


experts. In addition, a substantive proportion of experts (33.3%) considered the MBCT

“explore sources of support from others” (competence) to also target relatedness.

With respect to essentiality, all MBCTs were considered essential or important

techniques for self-determination theory-based interventions. A substantive minority (27.8%)

of experts expressed uncertainty over the importance of the “explore means to manage and

cope with pressure” (competence) MBCT.

In terms of uniqueness ratings, only six of the MBCTs were judged to be conceptually

unique and free of considerable overlap with other MBCTs9. From experts’ comments and

suggestions to reduce overlap, it became clear that, when answering this question, some

experts were considering the interactions that occur between MBCTs in a given intervention,

rather than their potential conceptual overlap (e.g., the “acknowledge and accept the client’s

perspectives” and “acknowledge feelings” MBCTs were rated as overlapping by 55.6% of

experts). In Round 3, instructions for this section were improved.

The ICC values showed good consensus on ratings of specificity (ICC = .929, 95% CI

[.873, .968]), essentiality (ICC = .784, 95% CI [.623, .902]), and uniqueness (ICC = .902, 95%

CI [.823, .957]).

Based on these ratings, one MBCT was removed (“Support client’s initiatives and

explorations around behavior change”), and two further MBCTs were added under the

autonomy need satisfaction category: “explore intrinsic rewards” and “encourage the person to

be supportive towards others with a similar condition”. Changes were also made to the wording

of the labels, definitions, and function descriptions of the MBCTs. The refined classification

comprised 25 MBCTs, classified under the autonomy (n = 9), relatedness (n = 8), and

competence (n = 8) need satisfaction categories, respectively10.

Finalizing the Classification: Steps 5 and 6

9Full details of overlapping MBCTs are provided in an online supplement: https://osf.io/cf3n7/ 10A full description of changes made to the MBCTs is provided in an online supplement: https://osf.io/2vh8y/

https://osf.io/cf3n7/https://osf.io/2vh8y/


In Round 3 of the expert consensus procedure, experts (n = 16) were asked to rate the

two additional MBCTs using the same procedure as in Round 211. With respect to the

uniqueness criterion, the majority of the experts (68.8%) judged the “encourage the person to

be supportive towards others with a similar condition” MBCT to be more relevant to

competence and relatedness needs rather than its original classification under the autonomy

need. Both new MBCTs were judged to be conceptually unique and not overlapping with all

the other MBCTs, except for the overlap between the “explore intrinsic rewards” and

“facilitate autonomous goals or outcomes” MBCTs (43.8% of experts).

In terms of specificity judgements, the “acknowledge and respect perspectives”

(relatedness), “ask permission to provide information or give advice” (relatedness), and

“explore sources of support from others” (competence) MBCTs, were again judged by a

substantive proportion of the experts (56.3%, 31.3%, and 43.7%, respectively) as targeting

autonomy and relatedness.

Focusing on the uniqueness ratings, most MBCTs from the previous round were still

judged by experts as overlapping with other MBCTs. However, the number of MBCTs with

which each MBCT was judged to overlap decreased. For example, the “explore life aspirations

and values” MBCT was considered to overlap with four other MBCTs in Round 2, while in the

current round it was judged by a majority (56.3%) of experts to overlap with the “facilitate

autonomous goals or outcomes” MBCT alone. In addition, the “show unconditional regard”

and “take interest the person” MBCTs were rated conceptually unique.

The ICC scores showed good consensus on ratings of specificity (ICC = .658, 95% CI

[.334, .859]), and uniqueness (ICC = .955, 95% CI [.917, .981]).

Based on the ratings and suggestions from experts on the wording of the MBCTs, the

core study team revised the list of MBCTs. For the autonomy need category, the new

11Full results of the consensus procedure for Round 3 are provided in an online supplement: https://osf.io/amnr4/

https://osf.io/amnr4/


“encourage the person to be supportive towards others with a similar condition” MBCT and the

“facilitate autonomous goals or outcomes” MBCT were consolidated into the “provide choice”

MBCT. The “acknowledge and respect perspectives” and “acknowledge feelings” MBCTs

were consolidated, and the “ask permission to provide information or give advice” MBCT was

removed and integrated with the “use empathic listening” MBCT. In addition, the “explore

sources of support from others” MBCT was reclassified from the competence need category to

the relatedness category. In addition, the wording of labels, definitions, and function

descriptions of the MBCTs was also revised based on experts’ suggestions. The final

classification of MBCTs (N = 21) with formal agreed labels, definitions, function descriptions,

and categorization according to their primary psychological need is presented in Table 312.

Commonalities with Other Taxonomies: Step 7

The core study team matched the final list of MBCTs produced after the Round 3

consensus procedure with key BCTs from BCTTv113. Seven MBCTs were considered

overlapping with existing BCTs, five of which were techniques hypothesized to improve

competence13. However, it is important to note that the definitions and function descriptions of

the MBCTs set these techniques aside from the matched BCTTv1. This is because each MBCT

is aligned with a theoretical construct from self-determination theory integral to the mechanism

by which it is purported to change motivation and behavior. Specifically, each MBCT is

defined in terms of the psychological need expected to mediate its effect on behavior change.

Whilst BCTTv1 has been linked using consensus and literature reviewing methods to

theoretical constructs (Carey et al., 2019; Connell et al., 2018), there has been no taxonomy or

classification linking MBCTs to the key constructs of self-determination theory. In addition,

12Illustrative examples of each MBCT for client-practitioner interactions are provided in an online supplement:

https://osf.io/mhw5x/ 13Full results of the matching exercise are provided in an online supplement: https://osf.io/8jtm3/

https://osf.io/mhw5x/https://osf.io/8jtm3/


the MBCTs are proposed to evoke change in motivation as well as behavior as end-points,

while techniques from BCTTv1 are exclusively defined in terms of changing behavior.

Discussion

The current research aimed to identify, describe, and classify the techniques employed

in motivation and behavior change interventions based on self-determination theory in health

contexts. The research extends knowledge on behavioral interventions based on the theory in

the health domain by providing a common set of terms and definitions for the identified

techniques. This classification is organized by the links between techniques and the

psychological need satisfaction constructs implicated in the mechanism by which the

techniques change motivation and behavior in accordance with Ryan et al.’s (2008) process

model (Figure 1). Consistent with the focus of self-determination theory on motivation quality,

techniques aimed at the end-points of motivation and behavior were labelled motivation and

behavior change techniques (MBCTs). We used an iterative expert consensus procedure to

identify, define, and classify techniques used in self-determination theory-based interventions,

similar to the procedures used to develop taxonomies of behavior change techniques (Michie et

al., 2005; Michie et al., 2013; Michie et al., 2015). This procedure yielded 21 MBCTs with

accompanying labels, definitions, and function descriptions, and each MBCT was classified

into autonomy, competence, and relatedness need satisfaction categories.

Interrelatedness Among Techniques and Relations to ‘Motivating Styles’

While the expert panel and iterative procedure used in the current analysis led to

general consensus on the techniques that comprise self-determination theory-based

interventions, and that each technique principally targeted change in one of the three basic

psychological needs, the experts also suggested that many of the techniques targeted change in

other needs. This is consistent with the premises of self-determination theory. Although clear

conceptual distinctions are proposed among the basic needs, the theory also states that the

needs are complimentary. According to Ryan and Deci (2017), “the three basic needs are


interdependent” because “the satisfaction of one need supports the satisfaction of the other two

needs” (p. 249). In addition, at the empirical level, measures of the three needs routinely

intercorrelate and factor analyses reveal that measures of satisfaction of the three psychological

needs form a higher order need satisfaction factor (Hagger, Chatzisarantis, & Harris, 2006).

That the MBCTs identified in the current research had close affinity to one need, but were also

linked to satisfaction of one or both of the other needs, is consistent with this premise.

Furthermore, although there is evidence to suggest that individual techniques can alone be

efficacious in changing motivation and outcomes (e.g., provision of choice, Patall, Cooper, &

Robinson, 2008), many techniques are designed to be used interactively. For instance, an

intervention providing a rationale for engaging in a task or behavior (MBCT5) is not likely to

promote autonomy satisfaction by itself, but a rationale paired with perspective taking

(MBCT1) and acknowledgement of negative feelings (MBCT8) is more likely to promote

autonomy satisfaction, and engagement (e.g., Deci et al., 1994; Jang et al., 2010; Reeve, Jang,

Hardre, & Omura, 2002). Similar effects have been found in the setting of intrinsic goals

(Vansteenkiste, Simons, Lens, & Sheldon, 2004; Vansteenkiste, Simons, Soenens, & Lens,

2004). Taken together, these theoretical perspectives and research suggest considerable

interrelatedness among the MBCTs and the underlying constructs they are proposed to change.

MBCT interrelatedness is consistent to the notion that promoting motivation change

using self-determination theory interventions involves adoption of ‘motivating styles’ by social

agents. Such ‘agents’ operate in multiple contexts such as healthcare (Williams & Deci, 1996),

education (Reeve & Jang, 2006), the workplace (Gagné & Deci, 2005), sport and coaching

(Carpentier & Mageau, 2016), parenting (Joussemet, Landry, & Koestner, 2008), and therapy

(Zuroff et al., 2007), and are responsible for supporting and nurturing autonomy among their

supervisees including patients, students, employees, athletes, and clients. The motivating styles

adopted by social agents frequently involve the simultaneous display of multiple MBCTs that

act synergistically in promoting need support and motivation change. Research has sought to


identify and describe motivating styles of social agents (Aelterman et al., 2019; Aelterman et

al., 2014; Delrue et al., 2019). A recent approach has been to characterize motivating styles in a

circumplex structure, with identified motivating styles differing in terms of their need-

supportive vs. need-thwarting character and their level of directiveness, with either the

motivating agent taking more the lead in the interaction or the person to be motivated being

more in charge (Aelterman et al., 2019). Within this circumplex, four broader motivating styles

get partitioned into two distinct approaches, that is, participative and attuning (i.e., autonomy

support), guiding and clarifying (i.e., structure), demanding and domineering (i.e., control),

abandoning and awaiting (i.e., chaos). These eight subareas display an ordered pattern with

individuals’ motivation and need satisfaction (Aelterman et al., 2019; Delrue et al., 2019), with

the most pronounced positive correlates being observed for the most need-nurturing

approaches (i.e., guiding, attuning) and the most negative correlates being observed for the

most need-thwarting approaches (i.e., domineering, abandoning). Interestingly, the other

identified subareas fall in between these two extremes, suggesting that some motivating

techniques are more strongly conducive to need satisfaction than others. This pattern of

gradations may also surface for the identified techniques herein, with some techniques being

more strongly conducive to the psychological needs and others instead creating the optimal

conditions for need satisfying experiences for clients to emerge.

The interrelatedness among the MBCTs and the adoption of a motivating styles

approach seems, at first glance, to be at loggerheads with the notion of identifying separate,

unique MBCTs. A primary function of taxonomies of behavior change techniques is to develop

a common set of descriptions and definitions of the unique techniques that comprise behavioral

interventions. A further goal of taxonomies is to provide researchers with means to develop

studies that isolate the unique and interactive effects of individual intervention techniques on

behavior change using factorial designs. This is aimed at developing optimally effective and

efficient interventions that work in given contexts, populations, and behaviors. Applying this


approach to produce the current classification of MBCTs serves a similar function, and allows

researchers to develop tests to establish the unique and interactive effects of the different

techniques of self-determination theory interventions in evoking change in need satisfaction,

motivation, and behavior. However, such a ‘micro’ approach to self-determination theory-

based interventions does not need to be irreconcilable with the more ‘macro’ approach

epitomized by motivating styles. In fact, they may be complimentary by using the classification

to describe specific groups of behaviors expected to be displayed in each motivating style.

Potentially, each style could be characterized by groups of MBCTs derived from the current

classification in a ‘profile’ approach, and this may be a direction for future research.

Mechanisms of Effect

A unique feature of the current classification of MBCTs is that it specifies explicit links

between the MBCTs and the psychological need satisfaction constructs from self-

determination theory. Organizing behavior change techniques according to the theoretical

constructs they are purported to change provides important information on how interventions

are likely to ‘work’ in changing behavior (Carey et al., 2019; Connell et al., 2018). The current

organization of MBCTs may inform efforts to identify possible mediators of intervention

effects, and, therefore, the mechanisms by which self-determination theory interventions

promote motivation change and affect outcomes (Hagger et al., 2020; Sheeran et al., 2017).

Consistent with the process model presented in Figure 1 (Ryan et al., 2008), employing the

MCBTs from the current classification in behavior interventions is expected to affect change in

the satisfaction of their respective psychological need. Specifically, autonomy-supportive

MBCTs are proposed to support autonomy need satisfaction in that they facilitate individuals’

sense of self-endorsed satisfaction, volition, sense of choice, ownership, and personal

endorsement of the task or behavior. Competence-supportive MBCTs are expected to support

competence need satisfaction through facilitation of individuals’ sense of satisfaction in

making progress, improvement, attaining mastery, and greater skill development on mental and


physical tasks and behaviors. Relatedness-supportive MBCTs are predicted to foster

relatedness need satisfaction by engendering individuals’ sense of interpersonal connectedness,

closeness, acceptance, understanding, intimacy, and unconditional regard. The links between

the MBCTs and specific need satisfaction constructs highlight the imperative of including

measures of the relevant need satisfaction constructs in research evaluating effects of MBCT-

based interventions to test the proposed mechanisms.

Links with Other Classifications of Techniques

We also compared the set of MBCTs identified in current classification with those from

BCTTv1 (Michie et al., 2013), a procedure which has been conducted for other classifications

of behavior change techniques (Hardcastle et al., 2017). The goal of the comparison was to

identify commonalities and redundancies across techniques and illustrate the distinctiveness of

the self-determination theory-based techniques identified in the current classification. Results

of the comparison illustrated that many of the MBCTs (five out of seven) classified under

competence need satisfaction shared similar content to those of existing taxonomies,

particularly the BCTTv1 (Michie et al., 2013). The congruent techniques are likely those aimed

at promoting change through changes in constructs such as self-efficacy, confidence, and

control. However, comparisons across the techniques from existing taxonomies should also be

interpreted in light of the explicit alignment of the MBCTs with self-determination theory, and

the focus on both motivation and behavior change. While recent work has specified links

between 56 behavior change techniques and 26 mechanisms of action (Carey et al., 2019;

Connell et al., 2018; Michie et al., 2015), these were not theory-specific. Although there were

techniques identified as having close content across the taxonomies in our comparison, we

opted to retain the MBCTs in the current classification because they have explicitly been

linked to the need satisfaction constructs from self-determination theory, and have a different

focus to those specified in existing taxonomies.

Strengths and Directions for Future Research


The current research advances knowledge by identifying the sets of techniques that

comprise self-determination theory-based interventions, providing a common set of labels and

descriptions for the techniques, and producing a classification system of the techniques with

basic psychological needs as an organizing principle. A major strength of the research is the

adoption of a rigorous expert-consensus procedure in order to arrive at agreed definitions,

descriptions, and classifications of self-determination theory intervention content. The panel of

experts comprised career researchers with considerable experience in applying self-

determination theory interventions across multiple behaviors, populations, and contexts, and

had in-depth knowledge of the extant research literature on self-determination theory

interventions. The panel applied this pooled knowledge in their evaluation of the candidate set

of techniques during the consensus rounds. The panel did not flag any omissions from the set,

lending support for its comprehensiveness. The procedure provided strong quality control over

the finalized terminology and descriptions of the techniques. Therefore, we are confident our

strategy was sufficiently comprehensive in identifying relevant techniques from the extant

literature, and developing common terms and descriptions of MBCTs that can be adopted by

future researchers to describe the content of self-determination theory-based interventions.

The present research also represents a step forward in specifying the content of self-

determination theory-based intervention in health behavior contexts. A key feature of our

classification system is the development of standardized labels, definitions, and function

descriptions for each MBCT. We encourage future researchers and interventionists to apply the

common terminology developed in the current classification when describing the content of

interventions based on self-determination theory. This will minimize variability and increase

precision in future descriptions of intervention content, and facilitate comparisons in content

across interventions based on self-determination theory, a key goal of classification systems

(Michie, Ashford, et al., 2011; Michie, Hyder, et al., 2011; Michie et al., 2013; Michie et al.,

2015).


In addition, we expect the increased capacity to directly compare intervention content

afforded by the classification will improve syntheses of evidence across self-determination

theory-based interventions, which have been somewhat hindered by a lack of consensus in

means to describe and characterize essential techniques that comprise these interventions

(Michie & Abraham, 2008; Ryan et al., 2008). The lack of consensus in descriptions creates

considerable problems for researchers attempting to synthesize findings across studies because

it makes it difficult to establish equivalence of intervention content across studies and,

therefore, evaluate intervention efficacy. The current classification is an essential pre-requisite

to the future development of coding systems that enable researchers to effectively link the

descriptions of self-determination theory interventions extracted from studies with the MBCTs

from the current classification (see Cane, Richardson, Johnston, Ladha, & Michie, 2015 for

examples; Michie et al., 2015). Together, such work will permit evaluation of the efficacy of

MBCTs in changing behavior through meta-analytic syntheses of intervention studies based on

self-determination theory. Such syntheses can assist in establishing whether the presence or

absence of specific MBCTs from the classification are efficacious in changing behavior. That,

in itself, is challenging given that few studies adopt factorial designs testing effects of

individual techniques, so such analyses are always going to be hampered by the presence of

other potentially confounding, co-occurring, or interacting techniques (Peters, de Bruin, &

Crutzen, 2015). Nevertheless, the current analysis is expected to pave the way for future

syntheses evaluating effects of individual, isolated intervention techniques based on self-

determination theory on behavior change, or the effects of particular combinations of

techniques. These syntheses contribute to the development of a database of information that

researchers can draw from when developing behavior change intervention based on self-


Related to the previous point, we expect the classification will help researchers develop

interventions testing the efficacy of particular techniques or groups of techniques in changing


motivation and behavior. We expect it will inform the development of studies using factorial

designs to test the unique and, importantly, interactive effects of groups of techniques on

motivational and behavioral outcomes. Such research may, ultimately, facilitate research

syntheses on the efficacy of individual technique in changing motivation and behavior of the

kind alluded to earlier. It will also inform the development of more efficient interventions

through the selection of techniques shown to be effective, and the elimination of those shown

to be ineffective, in changing motivation and behavior.

Our current research was developed in the domain of health behavior, a decision based

on the extensive research applying self-determination theory in this domain, and the

importance of behavior change and its maintenance to the prevention of chronic disease.

However, the classification system could be applied to behavior change interventions in

different domains, such as education and the workplace. Further research is needed to examine

the cross-domain generalizability of the MBCTs identified in the current classification. Further,

the expert consensus procedures adopted in the current research may also have implications for

the development of similar classifications of techniques for other theories in the motivation and

social psychological literature, and our approach based on theory, evidence, and expert

consensus may provide a template for doing so.

Limitations

Some limitations of the current research should be acknowledged. Although experts

were generally supportive of the use of psychological needs as a general organizing principle,

and that each MBCTs is classified under its ‘primary’ or most closely matched psychological

need but may also be related to other needs, no hierarchy is offered. In fact, for some MBCTs

there was debate among experts as to which of the need satisfaction constructs was the closest

match. While we report the ancillary need satisfaction constructs linked to the techniques in the

course of the consensus procedure, the current classification does not provide an elaborated


‘map’ of relations between the techniques and the needs they are likely to satisfy, and this

should be a goal of future research.

A further caveat is that although the links between psychological needs and the MBCTs

were derived through a rigorous expert-consensus procedure, they are not based on empirical

evidence from health behavior change interventions. So, the classification does not reflect the

quality or strength of evidence for the links that have been tested. Instead, the links specified in

the current classification should be viewed as guidance on the potential mediators of the effects

of MBCTs on motivation and behavior. The classification should, therefore, inform future

research that synthesizes evidence on the mechanisms by which self-determination theory-

based interventions change behavior, as well inform the design of studies to test proposed

relations for which no previous evidence exists or is lacking. In such cases, the links expressed

in the current classification should be treated as theoretical predictions subject to confirmation

or rejection through empirical tests (Hagger, Gucciardi, & Chatzisarantis, 2017). Such research

will move knowledge and understanding of which techniques work in changing motivation and

behavior in health contexts forward, and assist in identifying the mechanisms responsible. To

speculate, it may be that some individual or groups of MBCTs have larger effects on

motivational and behavioral outcomes than others, and over time cumulative empirical

evidence may assist in identifying a ‘core’ set of self-determination theory techniques that are

most reliably efficacious in changing motivation and behavior.

A related issue of note is that our classification of MBCTs is silent on the effects of the

techniques themselves on outcomes including motivation and behavior. In fact, this is a feature

of all taxonomies of behavior change techniques (e.g., Michie, Ashford, et al., 2011; Michie et

al., 2013). This is because the goal was to develop a means to describe and classify the content

of behavior change interventions based on self-determination theory, rather than providing an

evaluation of whether each technique is efficacious in determining change. In fact, such an

endeavor is difficult for the very reason the current classification was developed in the first


place – it is difficult to evaluate effects of techniques across studies because studies have

tended not to intervention content with sufficient precision, vary in the terms and language

used, and also differ in the number and combination of techniques used. As the field moves

toward more elaborated ontologies of behavior change (Larsen et al., 2016; Michie &

Johnston, 2017), the content of the current classification may be merged with syntheses of

research demonstrating MBCT efficacy and further links between MBCTs and constructs

representing mechanisms of effect. Such ontologies will provide intervention designers with

the comprehensive theory- and evidence-based knowledge necessary to develop interventions

that have optimal efficacy, and the current classification is an important step forward in their

development.

In addition, research is needed to determine whether specific MBCTs identified in the

current classification interact with conditions that moderate their efficacy in change and

maintenance of motivation, health behaviors, well-being, and disease burden. Such conditions

may include, but are not limited to, contact time between the practitioner or social agent and

the client or patient, frequency of contact, duration of intervention, type and training of social

agents (e.g., peer, family member, co-worker, teacher, clinician, or public health scientist), and

intervention cost. Once efficacy of interventions adopting individual or groups of MBCTs has

been established, they need to be tested for efficacy and effectiveness, cost-effectiveness,

implementation, and dissemination. In addition, the experts that contributed to the current

classification comprise largely of psychologists and behavioral scientists. Input is needed from

other stakeholders and practitioners (e.g., health professionals, teachers, public health

scientists, medical ethicists, peers, family members) who may assist in refining the content of

the current techniques, or may identify additional techniques that may satisfy psychological

needs and promote health behaviors that are currently not included in this classification.

Finally, recent research on self-determination theory has made the distinction between

need-supporting and need-thwarting strategies in evoking change in different types of


motivation and behavioral engagement (e.g., Bartholomew et al., 2011; Haerens et al., 2015;

Hein, Koka, & Hagger, 2015; Vansteenkiste & Ryan, 2013). While the lack of satisfaction of

psychological needs has been linked with reduced propensity to engage in behaviors for

autonomous reasons and reduced likelihood of attaining adaptive outcomes, including

behavioral persistence (Deci & Ryan, 2000; Deci, Spiegel, Ryan, Koestner, & Kauffman,

1982; Koestner, Ryan, Bernieri, & Holt, 1984), recent research has identified the deleterious

effects of thwarting or frustration of psychological needs on outcomes including behavioral

avoidance or disengagement (Bartholomew et al., 2011; Ryan & Deci, 2017; Vansteenkiste &

Ryan, 2013). In fact, recent theory has proposed a ‘dual process’ framework, proposing that

motivation is a function of need supportive and need thwarting processes that act in parallel

(Jang, Kim, & Reeve, 2016). Just as the need-supportive techniques identified in the current

classification enhance autonomous motivation, need thwarting strategies, such as controlling

interpersonal styles (e.g., use of contingent rewards), undermine autonomous motivation and

engender controlled motivation. Although avoidance of controlling techniques is referred to

within the current classification (e.g., “Use non-controlling, informational language”, MBCT

3), there has been no formal inclusion of techniques that thwart psychological needs. Future

research should seek to augment the current classification to encompass need-thwarting

techniques so that their effect can be also further explored and tested.

Conclusion

The present study developed an organized classification of the unique motivation and

behavior-change techniques (MBCTs) used in self-determination theory interventions to

change motivation toward, and participation in, health behavior. Our theory-based, expert

consensus procedure found support for 21 MBCTs organized according to the primary

psychological need (autonomy, competence, or relatedness) they are purported to change. A

key goal of the current classification is to provide researchers and interventionists with a

common set of terms and definitions to describe the content of self-determination theory-based


interventions in health contexts, and we expect it to facilitate the precision of descriptions of

future self-determination interventions. As with taxonomies of behavior change techniques, the

current classification is designed to be a first step in specifying the content of self-

determination theory-based interventions in health behavior contexts. The classification should

therefore be viewed as one that is flexible and open to modification as new evidence is made

available. Future research should aim to use the classification to inform the development of

self-determination theory-based interventions that test the efficacy of specific techniques in

changing health behavior. The classification system may also inform future coding of research

aimed at synthesizing evidence for self-determination theory-based interventions. Finally,

although the current classification is focused on health contexts, it may have broader

implications in other contexts. For example, the classification may form the basis of research

aimed at classifying and describing techniques used in self-determination theory-based

interventions in educational, organizational, and environmental contexts.


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A Classification of Motivation and Behavior Change Techniques … · 2020. 8. 6. · SELF-DETERMINATION THEORY AND BEHAVIOR CHANGE 1 A Classification of Motivation and Behavior Change